Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
566214244
Report Date:
08/08/2017
Date Signed
08/08/2017 04:25:19 PM
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office
,
6500 HOLLISTER AVE., SUITE 200
GOLETA
,
CA
93117
FACILITY NAME:
VENTURA BRANCH - FAMILY Y JUNIOR HIGH PROGRAM
FACILITY NUMBER:
566214244
ADMINISTRATOR:
JULIE O'BRIEN
FACILITY TYPE:
840
ADDRESS:
3760 TELEGRAPH RD.
TELEPHONE:
(805) 642-2131
CITY:
VENTURA
STATE:
CA
ZIP CODE:
93003
CAPACITY:
18
CENSUS:
0
DATE:
08/08/2017
TYPE OF VISIT:
Collateral
UNANNOUNCED
TIME BEGAN:
03:56 PM
MET WITH:
Julie O'Brien, Youth Programs Director
TIME COMPLETED:
04:27 PM
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LPA Stacie Merkes made an unannounced visit to this center for the purpose of delivering an amended report for signature. On 7/27/17 this LPA contacted Ms O'Brien to announce site 566207389 was granted an appeal and the report would be mailed for signature.
On 8/7/17 this LPA was contacted by Ms O'Brien to state she had not received the report. All the Ventura Branch YMCA sites operate exempt for the summer therefore LPA made a collateral visit to this site as this is where Ms O'Brien's office is located.
LPA delivered a copy of the amended report to the Director and was provided a signed copy for the file.
SUPERVISOR'S NAME:
Patricia S. Gutierrez
TELEPHONE:
(805) 562-0410
LICENSING EVALUATOR NAME:
Stacie Merkes
TELEPHONE:
(805) 698-7114
LICENSING EVALUATOR SIGNATURE:
DATE:
08/08/2017
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/08/2017
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809
(FAS) - (06/04)
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